In response to the ongoing concerns, NHS England has issued a 'letter of comfort' for GPs on the matter, as part of the new five-year GP contract - agreed by the BMA and NHS England.

The letter said: 'The OTC guidance includes specific reference to prescribers, and requires prescribers to reflect local policies in prescribing practice. In NHS England’s view, this guidance is “relevant guidance” under Regulation 94 and other relevant regulatory references.'

'Contractors are therefore required to have regard to this guidance and are able to follow the guidance and exercise judgement about when it is (and is not) appropriate to prescribe OTC items, without any risk that they will be in breach of their contract,' it added.

But despite this, the BMA said the letter 'does not remove GPs' professional responsibility'.

It said: 'NHS England will provide a "letter of comfort" to all practices and CCGs, stating that where a prescriber decides, in line with local and/or national guidance, not to provide a prescription for an over-the-counter medicine, practices will not be deemed to be in breach of their contract.

'This does not remove GPs professional responsibility to prescribe medications where they are deemed necessary.'

Clarifying this, a BMA spokesperson said: 'Necessary would be defined as it being in the patient’s best interest, particularly if there are concerns that the patient would not access the recommended treatment. This would be determined by the individual GP, who would use their professional and clinical judgment.'

One area of conflict here is the aim to get people to purchase their medications for hay fever and allergic rhinitis OTC. The evidence is very clear that the majority of those who see their GP do so because of failure of OTC medication be effective. There are numerous reasons for this, including the alternative diagnosis of non allergic rhinitis. The Practice which I attend has a notice virtually telling these people to go away. They are thus left to the tender
ministrations of pharmacists, who we must always remember are not clinicians.A recent study from Australia (where rhinitis is considered a pharmacy only disease) demonstrates poor patient outcomes.
The patient needs to be seen by a clinician to confirm diagnosis and to get a management plan. Once this has been done, and the medications needed are OTC then direct the patient to the pharmacist, but not the other way round. As a profession, we must not allow the CCGs or other bodies to dictate poor clinical practice which invariably leads to worse outcomes for our patients, delay in them receiving correct advice and prolonged periods of impaired quality of life.

This is absolutely typical of the woolly thinking and policy making to which we are subject. For goodness sake NHSE grow a backbone and simply blacklist all items that are readily available OTC. I really do not believe it when people say they cannot afford 32p for a pack of Paracetamol. The benefit of this also is that it encourages self-management of problems that all too readily present to primary care.

What a fudge! Do I need a letter of comfort? I've not been accused of a criminal offence! We either prescribe to all or refuse to all - leaving us to decide if someone can't afford it is really unacceptable. We will always get the "entitled Grauniad reader" patient who insists on a script and has the time to make life miserable as the complaint process (usually direct to NHSE thus involving the PAC) grinds through. Let's just get the clarity of NHS prescribable or not.